Secondary Conditions

Body dysmorphic disorder (BDD) sufferers often have “secondary conditions, including major depression, social anxiety and substance abuse,” Corboy said. Seventy-five percent of individuals with BDD will experience major depressive disorder in their lifetime (Phillips & Hollander, 2008).

Suicide also is common. Forty-five to 71 percent experience suicidal ideation due to BDD and 24 to 28 percent have attempted suicide — rates higher than in the U.S. population and other mental disorders (Phillips, 2006).

Kids and Teens

Though kids also can have BDD, the disorder usually develops during adolescence. But, because it’s often mistaken for normal teen appearance angst, it’s not diagnosed until much later.

Children’s symptoms are similar to those of adults, “in that they’re extremely upsetting, time consuming and commonly involve the face or head,” Greenberg said. But kids and teens are typically “more convinced that they are ‘ugly’ or ‘monstrous’ and that others are judging them based on their ‘flaws.’”

Compared with individuals who develop the disorder in adulthood, kids and teens are more likely to suffer from other disorders (substance abuse, social phobia, depression) — partially because BDD interferes with social opportunities and school during a critical time in development, Greenberg said. One study showed that 94 percent were impaired in social functioning, 85 percent in academic or work functioning and 18 percent had dropped out of school (Albertini & Phillips, 1999).

Young sufferers also are at greater risk for suicide. In the same study, 21 percent had attempted suicide (Albertini et al., 1999). When compared with adults, another study found higher rates of attempted suicide among adolescents (Phillips, Didie, Menard, Pagano & Weisberg, 2006).

Perceived Defects or Distorted Perceptions

It’s uncertain whether people with BDD actually see their defect as truly exaggerated or if they see the flaw accurately but process the information differently, Shepphird said. In one study, 53 percent of the sample “weren’t entirely convinced their deformity was real but couldn’t overcome their thoughts or intensity of distortions,” she said.

Neuropsychological studies suggest that “patients with BDD selectively attend to small details when organizing information in lieu of seeing the big picture and tend to misinterpret ambiguous stimuli as negative,” Greenberg said.

Preliminary neuroimaging research has found other differences, including “small detail (local) vs. whole picture (global) processing, executive dysfunction and potential biases in visual and visual-spatial processing,” she said. Some research also suggests that individuals with BDD have difficulty interpreting emotional expressions (see Saxena & Feusner, 2006).

References

Albertini, R.S., & Phillips, K.A. (1999). Thirty-three cases of body dysmorphic disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 38, 453–459.

O’Sullivan R.L., Phillips K.A., Keuthen N.J., & Wilhelm S. (1999). Near-fatal skin picking from delusional body dysmorphic disorder responsive to fluvoxamine. Psychosomatics, 40 (1), 79-81.

Phillips, K.A. (2006). The presentation of body dysmorphic disorder in medical settings. Primary Psychiatry, 13(7), 51-59.

Phillips, K.A., Didie, E.R., Menard, W., Pagano, M.E., Fay, C., & Weisberg, R.B. (2006). Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Research, 141, 305-314.

Phillips, K.A., & Hollander E. (2008). Treating body dysmorphic disorder with medication:
Evidence, misconceptions, and a suggested approach. Body Image, 5, 13–27.

Saxena, S., & Feusner, J.D. (2006). Toward a Neurobiology of Body Dysmorphic Disorder. Primary Psychiatry, 13 (7), 41-48.

Veale, D. (2000). Outcome of cosmetic surgery and “D.I.Y” surgery in patients with body dysmorphic disorder. Psychiatric Bulletin, 24, 218-221.

Additional Resources

A selection of BDD programs offering free evaluations and treatment options:

The Body Dysmorphic Disorder Program and the OCD Program at Massachusetts General Hospital
Phone: 617-726-6766, Toll free: 888-HEAL-BDD; Email: bdd@partners.org

The Body Image Program at Butler Hospital in Providence, RI
Phone: 401-455-6466; Email: bdd@butler.org

The BDD Program at Mount Sinai School of Medicine in New York
Phone: 212-369-5123; Email: holly.hamilton@mssm.edu

St. Louis Behavioral Medicine Institute offers help for BDD as well as many other psychological conditions.

EDReferral.com offers links to therapists and treatment in all 50 states as well as internationally.

Marriage and family therapist Tom Corboy founded and remains director of the OCD Center of Los Angeles.

Sari Shepphird, Ph.D is a Los Angeles-based psychologist who specializes in BDD and eating disorders.

Jennifer Greenberg, Ph.D is a Boston-based psychologist specializing in BDD.